title: Osteochondral scaffold reconstruction for complex knee lesions: a comparative evaluation.
abstract: BACKGROUND
  The primary aim of the present study is to evaluate the results obtained in challenging knee lesions with the implant of an osteochondral scaffold and concomitant treatment of all comorbidities. The secondary aim is to compare the results obtained with those found when a chondral scaffold was applied.
  
  
  METHODS
  Patients affected by complex lesions of the knee articular surface were included. "Complex cases" were defined according to the following criteria: previous clinical history of intra-articular fracture, lesion located at the tibial plateau, concurrent knee axial realignment procedure, concurrent meniscal scaffold or allograft implantation, and multiple articular surface lesions treated. Thirty-three patients were treated with the implantation of an osteochondral scaffold. The results of a homogeneous group of 23 patients previously treated and prospectively evaluated after implantation of a chondral scaffold were analyzed and compared.
  
  
  RESULTS
  IKDC subjective score improved significantly from pre-operative (40.4±14.1) to 12months' follow-up (69.6±17.0; p<0.0005) with a further improvement at the final evaluation at 24months (75.5±15.0; p=0.038). The same positive trend was confirmed by the VAS and Tegner scores. At final follow-up the group treated with the osteochondral scaffold presented a better subjective IKDC score with respect to the group treated with the chondral scaffold (p=0.034).
  
  
  CONCLUSIONS
  A regenerative procedure to address the entire osteochondral unit, together with the treatment of all comorbidities, might offer good results also in complex cases otherwise doomed to non-biological resurfacing.
  
  
  METHODS
  Comparative study.
authors.affiliation: Nano-Biotechnology Laboratory, II Orthopaedic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Filardo
authors.forename: E
authors.initials: E
authors.lastname: Kon
authors.forename: F
authors.initials: F
authors.lastname: Perdisa
authors.forename: B
authors.initials: B
authors.lastname: Di Matteo
authors.forename: A
authors.initials: A
authors.lastname: Di Martino
authors.forename: F
authors.initials: F
authors.lastname: Iacono
authors.forename: S
authors.initials: S
authors.lastname: Zaffagnini
authors.forename: F
authors.initials: F
authors.lastname: Balboni
authors.forename: V
authors.initials: V
authors.lastname: Vaccari
authors.forename: M
authors.initials: M
authors.lastname: Marcacci
mesh_terms: D000328:Adult; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D007718:Knee Injuries / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012038:Regeneration / Q000502:physiology; D018570:Risk Assessment; D054457:Tissue Scaffolds; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cartilage; Combined surgery; Complex cases; Osteochondral scaffold; Regenerative medicine